Optimalisatie van de werkingsprocessen van het Bijzonder ... - KCE

160 Special Solidarity Fund KCE Reports 133
Respondents don’t want to decrease their involvement in SSF files, and formulated the
following suggestions/remarks in order to increase efficiency and simplify the current
procedure:
• Sending every SSF file via the local sickness fund of the patient and in a
second step via the national level (medical director) towards the SSF has
no added value. Sending SSF files directly to the SSF could simplify
managing the files, create a single contact point, enhance transparency,
improve equal treatment and decrease waiting times. Only two
respondents assess the intervention of the sickness funds as positive to
detect potential alternative funding sources, to check the completeness of
the SSF file and have an advice formulated by the advisory physician.
• The global administrative workload (social service plus medical staff) is
high. The following examples were identified during the interviews:
o Administrative formalities for renewals although it is clear the patient
will need the treatment for a long period;
o Providing the same information for comparable cases resulting in
duplication of information (and workload) the SSF already possesses;
o Searching for information which is already at the disposal of sickness
funds;
o Searching for information which is already at the disposal of the SSF as
part of the NIHDI (financial costs of material, drugs, …);
o Obligation to provide the hospital’s invoice for the material or the
drug when entering a SSF file. This is a heavy administrative workload
and can easily be postponed till after a positive decision on the
application. For the financial department the search of invoices
(invoice to the hospital) is rather complicated since drugs and medical
devices are not bought piece by piece and invoices contain various
products;
o Non acceptance of a electronic signature on the medical file entered
by the prescribing medical doctor;
o For chronically ill children there are differences between the sickness
funds with respect to the required level of detail. It is judged as
unfeasible to provide all detailed information for all chronically ill
children. The time spent on one case was calculated by a hospital as
20 working hours;
• The procedures for appealing a decision from the SFF are not adequate.
Having to enter a petition to the Labour Court is a very heavy procedure.
Sickness funds are not very keen on this procedure since in fact it’s a
contestation of a decision that was partially taken by the sickness fund
itself or where the sickness fund at least was implicated. The patient has
to advance the cost of a medical expertise (€1.500 to €2.000) and in
practice it’s not feasible his/her treating medical doctor is present at the
moment of the expertise.